Demand for dialysis continues to climb

Demand for dialysis services continues to rise in the region as the population ages and diabetes and other kidney-related problems become more common, experts say.

Jefferson Regional Medical Center, University of Pittsburgh Medical Center and the West Penn Allegheny Health System are among the institutions reporting rising rates for the procedure that clears toxins from the blood when the kidneys, the body's filtration system, fail.

"In an aging population, you will see more renal failure," said Dr. Stephen Sandroni, director of the division of nephrology and hypertension at Allegheny General Hospital, where inpatient and outpatient dialysis procedures totaled nearly 59,000 in fiscal 2007, a 10 percent increase from 2006. "And no one early on predicted the explosion in obesity."

At UPMC's Oakland hospitals, 11,800 dialysis procedures were performed during calendar year 2006, a 17 percent increase from 2005, according to Dr. Jose Bernardo, medical director of the UPMC acute dialysis unit. Part of the rise was attributed to an increase in the number of intensive care beds and an increasing number of patients with complex medical problems.

Jefferson is coping with the increased demand for dialysis by doubling the size of its dialysis unit to six beds, according to Jewell Coulter, patient care manager for the hospital's intensive care and dialysis units. The unit provides an average of 10 treatments a day, compared with five or six treatments five years ago, she said. The new unit opens Sept. 17.

"It seems like dialysis units are getting busier and busier, and it doesn't seem to be just here," Coulter said.

Dialysis is provided both inside hospitals and at freestanding clinics, including ones owned by private companies. And even these companies, including Dialysis Clinic Inc., are reporting rising demand.

DCI, a nonprofit company based in Nashville, Tenn., is seeing annual increases for dialysis patients of 3 percent to 5 percent, according to Bob Kraynik, administrator for five of the 10 DCI clinics in Allegheny County.

"There has definitely been an increase in the number of end-stage renal disease patients in the past five years," he said.

At Allegheny General, plans are under way to increase the number of dialysis treatment stations within existing facilities, but details were not disclosed. DCI has no expansion plans, and UPMC officials were unavailable to discuss whether the rising number of dialysis cases would prompt expansion of services.

There is no standard for when a patient with kidney problems should start dialysis -- it's still a judgment call for doctors, according to Sandroni. But while the number of dialysis patients continues to climb in Allegheny County, the average age of the patient has been falling since 2000, according to ESRD Network 4, a nonprofit agency that tracks renal data for the federal government: age 70 in 2000 compared with age 64 as of June.

During the same period, the total number of people receiving dialysis in Allegheny County rose to 1,749 in June from 1,561 in 2000, according to ESRD data. Dr. Antonia Mendoza, Jefferson's head of nephrology, attributed the decline in age to better diagnosis of patients with kidney disease.

"We're better able to catch them earlier," she said.

Hospitals don't release profit margins for services, but Bill Buhr, a health care analyst at Chicago-based Morningstar Inc., said demand for dialysis has been growing at 6 percent a year for the past decade, with an estimated 2 million patients nationwide on dialysis. The biggest provider of the services is Waltham, Mass.-based Fresenius Medical Care, which operates six outpatient clinics in Allegheny County.

FMC reported net income of $179 million for the second quarter on $2.4 million in revenue, a 38 percent net revenue increase from the same period a year ago. The average revenue per dialysis treatment in the second quarter rose 3 percent to $327, and Buhr estimated the company's gross margin at 28 percent.